‘understanding your baby’: a short psycho educational

‘Understanding your Baby’: A shortpsycho educational course for new

parents

Rachel Eastaugh

Commissioned by Sue Ranger

Service Evaluation Project ‘Understanding your Baby’: A short psycho educational course

Prepared on the Leeds D.Clin.Psychol. Programme, 2017 2

Table of contents

Table of contents ............................................................................................................... 2

Commissioning .................................................................................................................. 3

Aims.................................................................................................................................... 3

Background ....................................................................................................................... 4

Infant mental health ........................................................................................................ 4Peri-natal maternal health promotion model................................................................... 5Attachment...................................................................................................................... 6Interventions ................................................................................................................... 7Why group interventions?............................................................................................... 8

Methodology ...................................................................................................................... 9

Participants...................................................................................................................... 9Design ............................................................................................................................. 9Measures used............................................................................................................... 10Interviews...................................................................................................................... 11Analysis......................................................................................................................... 11Ethics............................................................................................................................. 12

Results .............................................................................................................................. 12

Questionnaire results..................................................................................................... 12Discussion......................................................................................................................... 19

Conclusion ....................................................................................................................... 21

References ........................................................................................................................ 22

Appendices....................................................................................................................... 25



Commissioning

This Service Evaluation Project (SEP) was commissioned by Sue Ranger; Clinical

Psychologist and Team Manager of The Infant Mental Health Service based at the

Parkside Community Mental Health Centre. The Leeds Infant Mental Health Service

(IMHS) works with families both during in the antenatal stages and up to two years old.

The service is provided across the city and maintains a focus on attachment between the

parents and the infant.

The commissioner had developed and begun to pilot a four 1.5 hour session

psychoeducation group for parents with their 0-6 month old infants. Themes of the

sessions include ‘Your baby’s brain’, ‘Your relationship with your baby’, ‘Reading your

baby’, and ‘Your baby’s behaviour’. Family outreach workers deliver the sessions in

children’s centres. At present, three pilot courses have been rolled out, and the course

has been approved funding and has begun to be provided in centres city-wide. This SEP

has been commissioned with the aim of assessing the effectiveness of the group,

understanding the impact of the course specifically on parenting knowledge, and

identifying any areas for development of the course with regards to accessibility and

potential for maximum benefit.

Ethical approval was gained from the School of Medicine Research Ethics Committee

(SoMREC/SHREC project number - MREC16-121).

Aims

This SEP aimed to evaluate the effectiveness of the aforementioned psycho-

educational group in its intentions to improve parent’s knowledge and confidence.

The aim was to use a mixed methods design to gain feedback on the participant’s

experience of the group, and whether there had been any change in confidence or

knowledge following attending the group.



Background

Infant Mental Health and the understanding and importance placed on this area

has increased significantly in recent times, leading to a wealth of knowledge and a push

for more provision of services. Due to the strong evidence base demonstrating the

importance of a child’s first two years of life, a government cross party manifesto ‘1001

critical days’ was developed which outlined the government’s goal to improve

responsivity of care for every baby, and to improve confidence and levels of support for

new parents. The manifesto highlights the importance of services working with parents

early, and providing adequate support in the first two years of a child’s life (Leadsom,

Field, Burstow, & Lucas, 2013) As part of this government drive, the department of

education produced a report highlighting the importance of identifying need in this part

of the population and enabling provision of services (Wave Trust, 2013). The report

identifies the need for preventative as opposed to reactive strategies, and the long term

benefits of providing such support to the family themselves, as well as social and

economic systems.

It is clear that there is a strong focus on infant mental health within government

policy. The following literature review will demonstrate the current evidence around

infant mental health, and why early intervention is imperative in such a field.

Infant mental healthWithin the field of infant mental health, the first few years of an infant’s life are

widely recognised to be critical to their development. A new born baby is often thought

of as not fully developed at birth, hence requiring input from the world around them and

key caregivers. Such input, such as interaction with caregivers and basic needs being met,

are imperative for healthy development (Gerhardt, 2006). From a neurodevelopmental

perspective, it has been reported that the development of the brain is a lengthy process.

However, studies show us that the most significant and dramatic changes of the nervous

system occur within the initial few years of life, and indeed may form the basis for future

development (Phillips & Shonkoff, 2000), rendering associated early experiences critical.



Peri-natal maternal health promotion model

The initial months and years following the birth of a child are not only important

for the infant’s development, but also the health of the mother. The peri-natal maternal

health promotion model (Fahey & Shenassa, 2013) suggests that there are three key tasks

that a new mother must engage in to ensure a healthy post-partum period: physical

recovery, care of self, infant and family, and development of the maternal role

attainment. The model indicates that skills such as self-efficacy, positive coping, realistic

expectations and mobilisation of social support are required in order to achieve such

tasks, whilst also emphasising the importance of access to services, information and

support. To my knowledge, there has been little testing of this model to date, therefore

the validity of the model may be compromised. Having said this, the model is based on

evidence from studies on the post-partum needs of women and factors we know

determine maternal health (Fahey & Shenassa, 2013).

Figure 1. The Perinatal Maternal Health Promotion Model (Fahey & Shenassa, 2013)



Attachment

As emphasised in the perinatal maternal health promotion model, attainment of

the maternal role and therefore attachment between child and caregiver is imperative for

both infant and caregivers health. Due to the vast changes in the neurological system, and

the importance of early experiences within the first few years of a child’s life, the

parental role and attachment between baby and caregivers is vital. Throughout the early

stages of a child’s life, children use their caregiver as a safe base from which they can

explore the world. Bowlby (1969) proposed that infants arrive into the world already

pre-programmed to form attachments with their caregivers. It is thought that these

relationships are then used to guide an infant’s understanding of the world, and how they

fit within such a system; a concept Bowlby named an ‘internal working model’. Further,

demonstrating the importance of attachment within development, Ainsworth and Bell

(1970) utilised a research procedure ‘the strange situation’ in which infants were

observed playing, whilst caregivers and strangers come and go in different situations to

explore the infant’s response to threat and separation from their caregiver. Dependent

upon the child’s response to these situations, they were categorised into different

attachment styles; secure, anxious-resistant and avoidant (Ainsworth & Bell, 1970).

Attachment styles are generally understood to remain fairly constant throughout the life

span, and there is evidence to suggest that strong early attachments are imperative to the

individual’s wellbeing (Hamilton, 2000). In a study investigating the attachment styles of

individuals who have been in contact with mental health services, it was found that 81%

had an insecure attachment style (Mason, Platts, & Tyson, 2005). This study highlighted

the potential impact of attachment styles on an individual’s level of distress and need for

psychological services. Whilst this may be true however, it must be noted that attachment

styles within this study were assessed using self report measures such as Young’s schema

questionnaire (experiences of close relationships) and the clinical outcomes in routine

evaluation (CORE). Self-report questionnaires alone rely on reflexivity of the individual,

and accurate reporting in an area which may feel more challenging to be open and honest

in.



Attachment with caregivers is important from as early as pregnancy with regards

to the impact that it may have on the child’s life and development, hence the importance

of infant mental health service input when attachment between caregiver and child is of

concern (Bowlby 1969; Brandon, Pitts, Denton, Stringer, & Evans, 2009). Factors such as

parenting confidence and self efficacy have been reported to affect attachment, rendering

the process more problematic (Kohlhoff & Barnett, 2013; Sepa, Frodi & Ludvigsson

2004). Additionally, changing society and norms of family life have resulted in many

caregivers working full time to ensure provisions for their family, resulting in different

family dynamics and providing a more challenging context for development and

attachment (Philips & Shonkoff 2000). It is generally recognised that when caregivers

lack the resources or appropriate information to facilitate attachment and care for their

child, patterns may develop which may persist when the child themselves grows up and

has children of their own (Gerhardt, 2006), highlighting the importance of such services

further in preventing generational patterns.

Despite such concerns, the concept of neuroplasticity suggests that especially in

earlier years, brain development is not set in stone, and therefore can be impacted by the

correct intervention (Phillips & Shonkoff., 2000). Evidence suggests interventions

focused on the attachment, parental confidence and understanding can significantly

impact the relationship of child and caregiver, and ultimately break the chain in which

unhelpful patterns are passed on (Gerhardt, 2006). It is suggested that interventions are

most effective during pregnancy and within the first two years of the child’s life, due to

the importance of these years on the baby’s social development and emotional learning

and regulation (Phillips & Shonkoff, 2000).

Interventions

The method of psycho-education has been reported to be one of the most effective

evidence based interventions within the field of mental health (Lukens & McFarlane,

2004). A review of interventions aimed at educating parents about their new born babies

found a positive impact on maternal knowledge of infant behaviour (Bryanton & Beck,

2010). The review aimed to assess the impact of psycho-education interventions on four

different outcomes; infant growth and development, infant crying, infant sleeping, and



infant preventative care. Results from 25 studies were used to comprise meta-analyses;

including educational interventions on sleep enhancement (4) infant behaviour (13),

general post-birth health (2), infant care (2) and infant safety (3) and father involvement/

skills with infants (1). However usable data was only found from 15 of these studies.

Education around sleep enhancement had some effect on infant sleep, however no effect

was found on infant crying. Education around infant behaviour was found to increase

maternal knowledge, demonstrating the effectiveness of psycho-education on caregiver

knowledge, and infant behaviour. It should be noted that the trials included were reported

to be of small to moderate size and description of randomisation techniques, allocation

procedure and participants awareness of this were not always reported, leading to the

potential for bias within these studies. In addition, this review included all studies

whether they focused on individuals or groups, and reported being unable to carry out

subgroup analyses to understand any modifying impact of the intervention format. As the

course being evaluated in this service evaluation was a group programme, it is unclear

whether the impact of receiving the psycho-education in a group setting modifies the

outcomes.

Why group interventions?

A lack of resources combined with continually growing demands on

practitioners, means that services operating within the NHS are ever more stretched, and

are attempting to offer services for more people with fewer means (Appleby, Thompson

& Jabbal, 2014). Group interventions, in which therapeutic input is offered to multiple

individuals simultaneously can work to relieve some of these pressures, and there is a

range of evidence in carried out in different fields to suggest that group interventions can

be at least as effective as individual therapy (Sheard & Maguire 1999, Rickheim, Weaver,

Flader, & Kendall, 2002) and can facilitate a feeling of support and shared experience

(Lukens & McFarlane, 2004).

The current state of the literature base indicates that early attachments are

incredibly important in a child’s life, and that early interventions such as the



‘understanding your baby course’ can be helpful in modifying these attachments and

supporting healthy development.

The ‘Understanding your baby’ course is a psycho-education group for caregivers

with a 0-6 month old infant. The aim of the group is to increase knowledge and

confidence of such parents, with a specific focus on brain development, caregiver and

infant attachment, understanding cues from the baby, and the baby’s behaviour.

The aims of the SEP were to assess the effectiveness of the group, understand the

impact of the course specifically on parenting knowledge, and identifying any areas for

development of the course with regards to accessibility and potential for maximum

benefit.

Methodology

Participants

Participants of this study were all attendees of the ‘Understanding your baby’ pilot

courses run by the Leeds Infant Mental Health Team. Overall there were 19 participants

with an age range of 20 to 48, all caregivers of an infant between 0-6 months old.

Participants could either self refer to the course, or were referred by a health professional.

Design

A mixed methods design was used

- Sessional Questionnaire data (both quantitative and qualitative)

- Participants were invited to take part in a short interview

Using a mixed methods design allows for a more comprehensive representation of the

group members’ experiences and the effectiveness of the group. The quantitative data

allows for comparisons between individuals, and an ability to visually portray and

quantify the effectiveness of the group. In addition to this, the qualitative data from both

the questionnaires and the interviews expands upon the quantitative results with the

participants’ understanding, sense of meaning and exploration of depth to their responses.

It is to be noted that there are disadvantages with individual questionnaires and



interviews. For example, the inability to view group dynamics, which may become

evident with a research method such as focus groups. However, such a technique may

reduce the depth of individual responses and honesty due to the more 'public' nature of

the methodology (Grbich, 1998). As the course aims to increase individual knowledge

and confidence, and the purpose of the SEP is to assess whether individual knowledge

and confidence is improving, there is not a need to observe group dynamics. If group

dynamics are a salient issue with the ‘understanding your baby group’ it is reasonable to

think that this would come out as a theme in the individual interviews. Therefore the use

of interviews is appropriate for this SEP.

Measures used

Development of the measure

The questionnaire was developed by the service to specifically capture this

feedback for the service evaluation project. The questionnaire was self-report, made up of

5 questions with answers in the form of a likert scale marked 1 (not at all)-6 (extremely/ a

lot), and one open ended question, carried out pre and post session.

The questionnaire is not standardised and therefore there are no psychometric

properties available to evaluate reliable change. Despite this, the measure allowed us to

observe change pre and post each session and the course as a whole. The measure was

also tailored to suit the service needs and assess for appropriate change with regards to

the course aims (See Appendix A and B for copies of the pre and post questionnaires).

Administration of the measure

Each participant was requested to complete the questionnaires sessionally (pre

and post) by an assistant psychologist in the service who was not part of the facilitation of

the course.



Recruitment

Participants were reminded there was no obligation to take part in the project and

were approached by a researcher in order to try and reduce coercion. They were

informed that if they took part in the interviews that quotes may be used within the

report, however no identifiable details would be used, and that they would remain

anonymous throughout.

Interviews

Participants were invited to participate in short interviews lasting around 30

minutes. The interviews were carried out face to face in surestart childrens centres during

September and October 2017. Although efforts were made to recruit a larger sample, only

four participants took part in the interviews, due to participants either being

uncontactable or not wishing to take part, and time constraints. A topic guide was used to

elicit the participant’s experience, and follow up questions were used to expand on the

discussion and add depth to the understanding of the individual’s experience. See

Appendix C for a copy of the topic guide.

Analysis

Quantitative

Descriptive statistics were used to calculate means of group data both pre session and

post session for both the variables ‘confidence’ and ‘knowledge’. Descriptive statistics were

also used to calculate the mean rate of change per session.

Qualitative

Thematic analysis was used to analyse qualitative answers from sessional open ended

questions on the questionnaires, and analyse the interviews undertaken. Thematic analysis

allows exploration of the experiences and reality of participants through ascertaining themes

discussed within the answers (Braun & Clarke, 2006). Thematic analysis is carried out by



transcribing interviews, reading them multiple times and identifying themes across the data

set. Themes were identified on the basis of frequency, the poignancy of a concept and the

ability to capture something that would help answer the research questions (Braun & Clarke,

2006). Another psychologist in clinical training carried out credibility checks on the themes

identified by the researcher to assess validity of the themes.

Ethics

Ethical approval for the service evaluation project was sought and granted from the

School of Medicine Research Ethics Committee (SoMREC/SHREC project number-

MREC16-121). The Leeds Community Healthcare NHS trust local research and

development team concluded that the project was indeed a service evaluation project and

therefore no further ethical approval was required.

Information sheets and consent forms were distributed to all participants (see Appendix

D)

ResultsQuestionnaire results



Figure 2. Change in self-reported confidence and knowledge levels across four sessions

Figure 2 demonstrates an overall increase in confidence and knowledge levels across

the four sessions, albeit a small increase for confidence. As depicted, confidence levels and

knowledge levels did not increase at the same rate, however knowledge started at a lower

level than confidence.

Sessionnumber Confidence Knowledge

1 0.3 1.26

2 0.29 1.29

3 0.24 0.86

4 0.41 1

Table 1. demonstrating mean rate of change per session

Figure 3 above demonstrates the mean rate of change per session in both self-reported

confidence and knowledge levels. Overall, the rate of change was greater for knowledge

levels, indicating the course had a greater impact on parent’s knowledge and understanding

than their levels of confidence. However, this may be due to the high levels of confidence

throughout.

Qualitative data

Results from open questions of questionnaire

Pre- session questions included asking the participants to outline what they hoped

to gain from the session.



Figure 3. Pre-session question themes

Overall, participants made comments about hoping for a gain in knowledge,

particularly with regards to practicalities (routines, feeding and weening) and

understanding with regards to their baby’s development and brain development.

The final session saw comments becoming more future oriented, requesting for

information on further courses or sources of support. Interestingly, whilst most pre-

session qualitative comments matched the session content, indicating that participants

may have outlined their hopes and wishes to be consistent with the session’s aims, there

was an absence of comments around attachment and relationship which would have

corresponded with session 2. This may be that participants did not place as much

importance on these areas, or that they felt this was an area they did not need support

with.

Post session open ended questions asked the participants to comment on whether

the session met their hopes and wishes. These questions yielded themes of benefits

gained from ‘listening to others’, suggesting a beneficial component to the group

structure and learning from others.

‘Please tell us what youwould hope to gain’

Knowledge Further sources ofsupport

Practicalities(routines)

Understanding(baby’sdevelopment)



Figure 4. Post session question themes

It is of note that whilst pre-session comments centred around wishes for content

such as brain development and knowledge on routines, post session reflections centred

more around the social benefits of the group and a sense of a shared experience, for

example: ‘Great to get advice and share experiences with other mums’. Another key

theme from the question ‘Did the session meet hopes and wishes’ was the sense of

reassurance gained from the session (‘reassuring that you are fulfilling your baby’s

needs’), and information (‘Very informative’).

Finally, when asked what could be done better, themes of ‘more examples’ were

found. It seemed that participants valued the use of concrete examples within the sessions.

Did the session meethopes and wishes?

Interactionwith otherparents

Reassurance Information

Is there any more we could do to supportyou?

More tips and examples

Was there anything wecould have done better?

Clearobjectives

No

What did you enjoy themost?



Interview results

Figure 5. Interview themes

The thematic analysis from the interviews revealed that the overall experience of

the group was positive. When participants were asked what they would say to somebody

thinking about doing the course, comments were made such as ‘Do it, if you want advice

or to understand more’ and ‘Do it, it’s worth your while, it’s not a waste of time…

beneficiary’.

The analysis of the interviews revealed four key themes as can be seen above in

Figure 6. Each key theme will be outlined, along with the subsequent sub themes.

The first key theme to emerge from the data was ‘Support’.

Throughout the interviews there was an overwhelming sense of feeling supported and

gaining a sense of connectedness from the groups. This incorporates two subthemes;

‘similarity’ and ‘new relationships’. ‘Similarity’ in which participants felt it was useful



for their child to be around infants of a similar age, both for their child’s benefit, and for

their own as a parent to aid with comparison, seeing that all children develop differently

and sharing useful tips and knowledge. Participants also spoke highly of the ‘new

relationships’ they had formed both with the facilitators and other group members.

These relationships were often described as being relationships that have continued

following the group and provided a sense of safety. For example one participant

described how ‘The course made it easier to just calm down and know that if something

does happen, there are people there’.

Another major theme was ‘Attunement’ and the idea that participants felt closer

to their baby in some way following the course. This was described in ‘closeness and

bonding’, in which participants described feeling in some way closer to their baby

following the course, sometimes through having more understanding, and sometimes

through confidence . For example one participant said ‘I already understood him, but it’s

helped me get closer to him, bonding-wise, I was too scared to get close’. In a similar

way, some participants spoke about understanding with regards to the different cries; ‘I

always wondered how you differentiate the cries, and being on that course kind of helped

point it out’. Despite this being knowledge related, when participants spoke about being

able to differentiate between the cries it was often linked to a discussion about

understanding their baby, suggesting this knowledge helped bring caregiver and baby

closer. Finally, the interviews revealed that the course facilitated the caregiver and baby

to be more ‘in sync’, and at one with each other. This was demonstrated in quotes such as

‘I understand him better, we’ve been laughing, crying…his facial expressions’.

Supporting the emergent themes from the sessional open ended questions, the

interviews revealed a major theme to be ‘Knowledge’. Participants referred to knowledge

they had gained, and how it had impacted them, their behaviour and their confidence.

Knowledge was either referred to as being gained from anew; ‘first baby so found it

reassuring’, revisiting or reconfirming information they already knew. For example one

participant noted ‘I had no idea about some of the medical stuff’. Within the interviews,

there was also a sense that there was always more to learn, and perhaps there were things

participants were not aware that they did not know. This concept was captured within the

sub theme identified as ‘Acquisition expansion revision’; ‘I thought I knew quite a lot,



but it turned out there was more you can learn no matter what’. Additional knowledge

came from peers, as participants noted the importance of sharing tips and own

experiences in the sub theme ‘Sharing knowledge’. From this, ‘changing behaviour’

took place as participants identified that they were able to take such knowledge and adapt

their behaviour at home in line with what they had learned. Further, the provision of

information led to a sense of ‘reassurance’. Many described hearing the information on

routines and looking after their baby reassuring that they were doing the right thing. In

particular, one participant described how the level of reassurance needed changed over

the course of the four sessions with this being more important in the earlier sessions;

‘More at the beginning it was reassurance’.

Finally, there was discussion about the context within which all the above benefits

and changes were able to take place; a theme identified as ‘facilitators and inhibitors of

a conducive environment’. Due to the nature of the course, group members had their

young baby with them whilst undertaking the course. Whilst many participants seemed to

have a strong opinion on this, there was a mix of views as to the impact of ‘having their

baby with them’. For example one participant said that it was ‘good to have baby in the

room as wouldn’t have been able to leave him’, whilst another participant named the

benefit of ‘having the baby in the room gave him a chance to interact with other babies

the same age’. On the other hand, other participants felt that ‘having baby in the room

wasn’t always easy, hard to concentrate, and [due to] having to go out with him a lot,

missed a lot of content’. Similarly, participants felt the level of ‘flexibility’ that

accompanied the course was important in creating an optimal environment. One

participant noted the general flexibility of the course ethos stating the course were ‘very

willing to adapt to what you needed’. Many participants discussed the benefits of being

able to leave the room with their baby when necessary (to feed or if crying), and being

able to catch up with information if the participant was unable to make one of the

sessions. There were mixed views on the timing of the sessions. Three participants out of

four commented on the timing being appropriate and positive with regards to the length

of the sessions and the time at which they were held. One participant however presented

an alternative view to the timing of the sessions, noting that the 3pm finish time was

difficult with regards to picking up other children from school.



Another consideration with regards to the environment was the ‘gender mix’ of

the groups. Most views presented were that having men in the group was helpful, with

comments being made such as ‘really quite an eye opener’. However, there was also

comments made around the male member feeling ‘awkward’ in the group. Suggestions

were made to ‘encourage more men to attend’, as one participant named that parenting is

‘still seen as a women’s job but [the group] would be helpful for men too’.

Finally, a strong sub theme was the overarching ‘relaxed environment’,

specifically with regards to an informal setting. Participants described how the

informality felt in some way enabling; ‘It was good as you didn’t feel as if you had to

hide’, and ‘You could give your views whenever you wanted as it was very informal’.

Discussion

The aims of this SEP were to evaluate the ‘Understanding your baby’ psycho-

education course on changes to confidence and knowledge using a mixed methods design.

Overall the results suggested that the ‘Understanding your baby’ course had a

positive impact on parental knowledge and confidence.

The quantitative results show that the group was helpful in increasing participants’

overall confidence and knowledge with regards to understanding their baby. As discussed

previously, the quantitative data from the questionnaires indicate that the course had the most

significant impact on the group member’s knowledge, despite improvements being seen in

both areas. As knowledge and confidence increased at different rates, there may be scope to

wonder what else affects confidence levels apart from knowledge, and how the group may be

able to include this to maximise impact for group members. Alternatively, it may be about

exploring confidence in more detail, and considering different ways of capturing confidence

changes and the subtleties that can be associated with this. The qualitative data from the

questionnaires indicated that participants felt they gained from the social aspect of the group,

feeling a sense of shared experience and having the opportunity to engage with other mums.

In the open ended questions asking about what could be done better, themes of ‘more

examples’ were found. It may be that dedicating more time to discussions around concrete

examples, and how the information may practically relate at home, may aid the increase in

confidence previously discussed.



Analysis of the interviews revealed an overwhelmingly positive appraisal of the course

by those in attendance. The four key themes revealed through the interviews; ‘Support’,

‘Attunement’, ‘Facilitators and Inhibitors of a conducive environment’ and ‘Knowledge’

provided further evidence that group members felt supported and gained a sense of

reassurance from the course .The emergent themes also suggest that the course can aid

bonding and help parents feel more attuned to their baby, whilst improving infant mental

health knowledge and behaviour change. Finally, whilst there were mixed views on the

gender mix, and the impact of group members having their baby in the room, a strong theme

to emerge was the environment and how overall benefits from the course were enabled

through the relaxed and informal environment that the course was delivered in.

The results are consistent with the published literature base on the benefits and

effectiveness of psycho-education interventions in the post-natal stage (Bryanton & Beck,

2010). The thematic analysis has also provided support for the literature reporting gains of

support and shared experience from group settings (Lukens & McFarlane, 2004). Overall,

the results provide support for the ongoing development and provision of the ‘Understanding

Your Baby ‘course currently being rolled out in centres city wide.

Limitations

It is important to note the time lapse between the participants having attended the

course and the time the interviews took place. For many of the participants there will have

been up to a year in-between the time they undertook the course and when they were

interviewed, perhaps leading to a lower accuracy of recall and the potential for more

confounding variables such as extra knowledge gained from elsewhere, which I have not

accounted for within the research. On the other hand however, the time in-between the course

and the interview may have allowed more time to reflect on the course and how helpful it has

been, whilst putting some of the knowledge acquired on the course into practice.

In addition to this, as previously discussed the measures used were useful for this

SEP as they were tailored to the service and the specific group aims. However, due to them

not being standardised and therefore not having psychometric properties, it was not within

the scope of this SEP to calculate reliable change. Finally, the sample size was small, and

confidence levels of the participants was already high, therefore limiting the generalisability

of the results.



The findings from this SEP have been presented to the commissioning service, the

Infant Mental Health service, both in person and within a report. In addition to this, the

findings have also been presented at the University of Leeds, DClin Psychol SEP conference,

October 2017.

Conclusion

The practical implications of the service evaluation project include support for the

role out of the course across the city. Recommendations from the SEP include: including

more concrete examples, or allowing more time to discuss more concrete examples to

further increase confidence and practicality of the course. In addition to this, trying to

encourage more fathers to attend. Recommendations for further evaluation include using

a standardised measure with published norms, in order to evaluate the clinical

significance of the change reported within this SEP.



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Appendices Outline

A- Questionnaire example- Pre sessionB- Questionnaire Example- Post SessionC- Interview schedule/ topic guideD- Information sheet/ consent formE- Attendance DetailsF- Self appraisalG- Commissioners appraisal

Appendices

Appendix A. Pre session questionnaire

Date Participant number SessionNumber: 1

The following questions relate to how you’refeeling about certain parenting skills and tasks.

Please tick the box that best reflects how

confident you feel about:

Understanding what your baby wants andneeds

Not at all Extremely

1 2 3 4 5 6

Responding to your baby’s needs appropriately


1 2 3 4 5 6

Bonding with your baby


1 2 3 4 5 6

Please tick the box that best reflects your

Please tell us more about what youexpect to gain from today’s session



current knowledge of:

Infant brain development

Not at all A lot

1 2 3 4 5 6

Ways to support your baby’s healthy braindevelopment

Not at all A lot

1 2 3 4 5 6

Appendix B. Post session questionnaire

Date Participant number SessionNumber: 3

The following questions relate to how you’refeeling about certain parenting skills and tasks.

Please tick the box that best reflects how

confident you feel about:

Understanding what your baby wants andneeds


1 2 3 4 5 6

Responding to your baby’s needs appropriately


1 2 3 4 5 6

Bonding with your baby


1 2 3 4 5 6

Please tick the box that best reflects your

current knowledge of:

Please tell us more about what youexpect to gain from today’s session



Infant states and cues

Not at all A lot

1 2 3 4 5 6

Ways that your baby communicates their needs

Not at all A lot

1 2 3 4 5 6



Appendix C. Topic Guide

- How did you find taking part in the group?

- What were your thoughts about the course practically (i.e. were the sessions the

right length/ the number of them/ having baby in the room?)

- What have you taken away from the course? P

- Is there anything you would change or like to see added to the course?

- Is there anything that has surprised you?

- Is there anything that you found less helpful?

- How well do you feel you understand your baby following the course?

- Extra- If you could talk to people thinking about attending the course, what would

you say to them?



Appendix D. Information sheet and consent forms

Understanding your Baby: A Course for Parents and CarersOutline of Service Evaluation

The Course‘Understanding your Baby: A Course for Parents and Carers’ was developed by membersof the Infant Mental Health Service to be delivered as part of the Universal Early StartPathway in Leeds. The pilot will be facilitated by Family Outreach Workers (FOWs)employed by Leeds City Council within Surestart Children’s Centres. 10 facilitatorsattended a one-day facilitator training led by the Consultant Clinical Psychologist andSpecialist Health Visitor from the Infant Mental Health Service in October, 2016. TheFOWs delivering the group have also attended ‘Babies, Brains and Bonding’ and‘Supporting parents to understand their babies: applying attachment theory’ trainings heldby the Infant Mental Health Service. The Assistant Psychologist from the Infant MentalHealth Service (who has also attended the training) will support FOWs in the facilitationof each of the pilot sessions.

The course consists of four sessions, each lasting 1.5 hours. The sessions will be heldonce per week over a 4 week period and the first session will commence in November,2016.

Session 1: Your Baby’s BrainSession 2: Your Relationship with your BabySession 3: Reading your BabySession 4: Your Baby’s Behaviour

AimsThe aim of the evaluation is to understand the impact of the course on parentingknowledge and confidence. We would also like to know about the delivery; whether theyfound the course accessible and enjoyable.

ParticipantsThe participants of the evaluation will be parents or carers of infants aged 3 to 6 monthsold who have volunteered to attend the course at their local Children’s Centre. As thecourse is part of the Universal Pathway, it will be accessible to all parents and carers whoare interested in attending. Recruitment will be carried out within the Children’s Centreby the course facilitators.

EvaluationParticipants will be provided with an information sheet (Appendix A) by the AssistantPsychologist (AP) and asked to sign a consent form (Appendix B). The AP will thenprovide the participant with the opportunity to ask questions regarding the evaluation. Ifthe participant agrees to take part in the evaluation and signs the consent form, they willbe asked to fill in a short registration form (Appendix C) and the appropriate pre-sessionevaluation form (these are different for each session; appendices D-G). Following the



session, participants will then be asked to complete the appropriate post-sessionevaluation form (different for each session; appendices H-K) and a further evaluationform (Appendix L).

Data ProtectionWe will comply fully with the Data Protection Act (1998). Completed questionnaires willonly be identifiable by a participant number and will be stored in a locked cabinet atParkside Community Health Centre. Registration forms will be kept separately in alocked cabinet. Data from the questionnaires will be entered onto a password-protectedMS Excel spreadsheet on a Leeds Community Healthcare computer. Only members ofthe research team will have access.



Understanding your Baby: A Course for Parents and CarersEvaluation Consent Form

As ‘Understanding your Baby: A Course for Parents and Carers’ is a new project, wewould like to ask you to fill in some short questionnaires to help us to evaluate itseffectiveness. We will ask you to complete several questionnaires throughout the durationof the course. The aim is to find out about the impact of the course on parentingknowledge and confidence, and overall enjoyment of the group.We are asking for your permission to use the information collected from thequestionnaires in future service evaluation, audit and research. When used for thesepurposes, all of the information will be anonymous, that is, your name and anypersonal data which might identify you will be removed. The information will besecurely held, only people within the research team are allowed to see the informationand we comply with Data Protection Laws.

Please

Initial

I have read and understood the information above. I have had thechance to discuss this with a member of the team.

I give my permission for the data collected from these questionnairesto be used for audit, research and service evaluation purposes.

I understand that if I change my mind and wish to withdraw my datafrom the audit/research, I can do so at any time (including after I haveleft the course) and this will not affect my participation in the course,the support that I receive or my legal rights.

__________________________ ______________________________________________Service user name: Signature: Date:

__________________________ ______________________________________________Researcher name: Signature: Date:

Thank you for your cooperation



Appendix E. Attendance Data

Overall attendance by session

Sessionnumber

Overallattendance

1 89.47%

2 68.42%

3 68.42%

4 57.89%

Attendance by centre

Centre

Averageattendanceacross all foursessions

1 60%

2 67%

3 81%

‘understanding your baby’: a short psycho educational

Documents